Originally from Dispute Resolution Journal

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Mediation has been largely overlooked as a tool that can resolve the common disputes in America’s nursing homes.  Usually, residents file a complaint against a nursing home through a standard grievance procedure. When the outcome of the grievance resolution process is unsatisfactory, they file for arbitration instead.  Mediation would be an important first step before arbitration in theory and in practice for the resolution of the emotional, complicated disputes that are characteristic of conflicts that arise in nursing homes. 

I.    DEFINING THE NURSING HOME ENVIRONMENT IN THE UNITED STATES 

1.4 million Americans received care in 15,700 nursing homes in 2012.  A majority of these residents were women (67.7%) and 85 or older (42.3%). 68.2% of nursing homes were for-profit, though they also had non-profit and government ownership structures. On any given day, nursing homes served an average of 88 residents, though average daily nursing home capacity is 106.   

An individual qualifies for skilled care in a nursing home when they have limited functionality, as measured by their ability to perform the five basic activities of daily living (ADLs): bathing, dressing, toileting, transferring, and eating.  ADLs are personal care needs that are a key indicator of whether it is safe for an individual to live independently in a private residence. According to 2012 estimates by the Centers for Disease Control (CDC), nursing homes provided care to individuals most deficient in each of the ADL categories: 96.1% of residents needed assistance bathing, 90.9% dressing, 86.6% toileting, and 56% eating (2013). Short-term stay patients, who usually receive post-surgery or post-hospitalization transitional rehabilitation, work with nursing home staff to develop care plans with the ultimate goal to improve their ADLs. Long-term stay nursing home residents also work to improve their ADL scores, though it is unlikely that they will return to their private residence.  Approximately 50% of these residents also have Alzheimer’s disease or other forms of dementia, a form of cognitive impairment that only worsens with time and must ultimately be managed in a skilled facility like a nursing home.   As residents near the end of their lives, they may opt to receive hospice or palliative care in a nursing home setting.